"The NHS will last as long as there are folk left with the faith to fight for it"Aneurin Bevan

Monday, 11 January 2010

Conservative Draft Manifesto 2010: Dissection Part 7

An analysis of the Conservative Draft Manifesto 2010.

A More Accessible and Accountable NHS

"hospitals will not be paid in full for a treatment which leaves a patient with an avoidable infection."

It is difficult to understand the motivation behind this policy. Hospitals are not awash with money. Cameron knows this, which is why he has not only made his "ring-fence" promise but has pledged to increase funding. So why is he promising to cut hospital funding like this?

If a hospital has a problem with hospital-acquired infections (note hospital-acquired often patients bring infections in with them) then clearly they need additional investment to sort out the source of the infection. Cutting their funding will mean one of two things: either no steps will be taken to improve infection rates (they don't have the money, so how can they do anything?) or they will take funding from elsewhere (and consequently, something else will suffer). Either option seem daft, and so it is a daft policy to implement.

This is an example of the new Conservative payment according to outcomes. It is based on a shoddy assumption that by cutting funding you can improve quality. Paying hospitals less (as the Tory policy suggests) will not solve hospital problems, it will increase the problems and make hospital acquired infections more likely. Also, who determines that a hospital is to blame for an outcome? Nothing in healthcare is exact. A patient is not qualified to be able to determine if their infection was hospital-acquired, or that they brought the infection into the hospital (as happens frequently with MRSA). The hospital trust should not be entrusted with determining whether the infection was their fault, because clearly they have a vested interest (and now under Cameron's plans they will have a financial interest when it should be a healthcare issue). So the outcome could only be determined by a third party. This will increase administration and cost, but since Cameron intends to cut administration by one third, it is unclear how his payment according to outcomes policy can be implemented.

For all of the reasons I have listed above it is clear that this policy will fail. My guess is that it will be replaced soon after it is implemented, if it is implemented at all.